Early mobilization in intensive care Experiences of patients and healthcare professionals, and a comparison of physiological responses during mobilization

Abstract

Introduction. Early mobilization in intensive care is frequently used to prevent physical and psychological complications, with promising results. As its significance becomes increasingly apparent, understanding the complex experiences of patients in intensive care becomes important. While EM is considered both feasible and beneficial, its requirement for patient participation poses several challenges for healthcare professionals. Therefore, exploring the experiences of both patients and healthcare professionals becomes critical to identifying factors essential for successful early mobilization. Furthermore, research on the relative safety and effectiveness of different mobilization interventions is limited. Aim. The overall aim of this thesis was to contribute to evidence-based practices concerning early mobilization of patients in intensive care, ultimately alleviating suffering and mitigating the physical and psychological consequences associated with critical illness. Therefore, the purpose was to enhance the knowledge regarding patients’ and healthcare professionals’ experiences and perspectives on early mobilization within the ICU setting and to investigate the physiological responses between two different mobilization positions. Methods. Three interview studies and one clinical trial were conducted to explore early mobilization in intensive care from several different perspectives. In Study I, 19 former patients participated in semi-structured interviews three to four months after discharge. The interviews were analyzed using qualitative, inductive content analysis. In Study II, semi-structured interviews were conducted with 17 intensive care healthcare professionals, including nurses, assistant nurses, and physiotherapists, and analyzed using a phenomenographic methodology. In Study III, a pragmatic randomized, clinical, crossover trial was performed, involving 47 patients, randomized to begin sitting semi-recumbent in bed or a chair. Data collected included hemodynamic and respiratory variables alongside self-rated measures of pain, exertion, and satisfaction. In Study IV, 30 patients were interviewed within one week after discharge from intensive care. The interviews were analyzed with a hermeneutic, interpretive approach. Results. Studies I and IV indicated that EM was perceived as the beginning of recovery. It provided a sense of familiarity and progress, reigniting hope and fighting spirit despite the effort required. Furthermore, it could mitigate confusion and disorientation. A supportive and encouraging interaction with HCPs was crucial to this process and a pre-existing understanding that resilience and persistence were essential for regaining strength and mobility. Patients generally favored sitting in a chair over remaining in a semi recumbent position in bed. Study III further indicated that sitting in a chair was just as demanding as sitting semi-recumbent in bed, from a physiological perspective. Study II highlighted that healthcare professionals view EM as an integral and essential part of care, aimed at preventing complications. They reported various patient responses to EM and emphasized the importance of a person-centred approach, involving patients in the mobilization process. Conclusions and clinical implications. Early mobilization is an existential matter. In addition to its physiological advantages, it provides psychological and existential benefits. EM facilitates recovery by addressing both the body and mind, restoring their interconnection. It is perceived as the beginning of the recovery process and ignites hope, particularly when it includes leaving the bed. Good interaction with healthcare professionals is essential. Early mobilization should be performed with a person-centred approach, recognizing the patient’s inherent will to fight for independence and involving the patients as partners in the process.